Bleeders Bleed, and Snakebites Don’t Help

A guest post by Justin Hensley (@EBMGoneWild) of Evidence-Based Medicine Gone Wild.

As the population ages, and the drug companies convince more and more  people to take drugs, new trends start showing up in medicine. One of them is patients taking antiplatelet and anticoagulant medications having other problems. Certainly there has been trauma literature on patients taking those medications, and now there is a toxicologic study.

In said study, the authors went back into their huge rattlesnake bite database in Arizona to identify those patients who were taking antiplatelet and/or anticoagulant medications. Comically, there were patients who had multiple snakebites, but they were only enrolled for their first bite. Also one patient was taking aspirin, clopidogrel, and warfarin, to go ahead and knock out any chance of hemostasis. They then looked for “early bleeding”, “late bleeding” or bleeding “at any time.” Major bleeding was markedly increased over controls, as was early bleeding and late bleeding. Length of stay and use of antivenom was not significantly different, however.


Take home messages? Antivenom does not correct coagulopathies secondary to medications, and late bleeding is much higher in patients on those medications, so laboratory observation of those patients should be extended. Also, avoid traipsing through rattlesnake country if you’re on blood thinners.
Bleeding Following Rattlesnake Envenomation in Patients With Preenvenomation Use of Antiplatelet or Anticoagulant Medications.

“Bleeding Following Rattlesnake Envenomation in Patients With Preenvenomation Use of Antiplatelet or Anticoagulant Medications.”
http://www.ncbi.nlm.nih.gov/pubmed/24628755